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Wednesday, March 23, 2016

#mhandwork Selection of readings on recession, policy and well-being

Below is a selection of readings that are relevant to our workshop tomorrow (Thursday 24th March 2016) on mental health and work. See also the following post for readings on employment policy and well-being.

Economic stressors have been retrospectively associated with net population increases in nonspecific psychological distress (PD). However, no sentinels exist to evaluate contemporaneous associations. Aggregate Internet search query surveillance was used to monitor population changes in PD around the United States' Great Recession.

Methods

Monthly PD query trends were compared with unemployment, underemployment, homes in delinquency and foreclosure, median home value or sale prices, and S&P 500 trends for 2004–2010. Time series analyses, where economic indicators predicted PD one to seven months into the future, were performed in 2011.

Results

PD queries surpassed 1,000,000 per month, of which 300,000 may be attributable to the Great Recession. A one percentage point increase in mortgage delinquencies and foreclosures was associated with a 16% (95%CI, 9–24) increase in PD queries one-month, and 11% (95%CI, 3–18) four months later, in reference to a pre-Great Recession mean. Unemployment and underemployment had similar associations half and one-quarter the intensity. “Anxiety disorder”, “what is depression”, “signs of depression”, “depression symptoms”, and “symptoms of depression” were the queries exhibiting the strongest associations with mortgage delinquencies and foreclosures, unemployment or underemployment. Housing prices and S&P 500 trends were not associated with PD queries.

Limitations

A non-traditional measure of PD was used. It is unclear if actual clinically significant depression or anxiety increased during the Great Recession. Alternative explanations for strong associations between the Great Recession and PD queries, such as media, were explored and rejected.

Conclusions

Because the economy is constantly changing, this work not only provides a snapshot of recent associations between the economy and PD queries but also a framework and toolkit for real-time surveillance going forward. Health resources, clinician screening patterns, and policy debate may be informed by changes in PD query trends.

The social norm of unemployment suggests that aggregate unemployment reduces the well-being of the employed, but has a far smaller effect on the unemployed. We use German panel data to reproduce this standard result, but then suggest that the appropriate distinction may not be between employment and unemployment, but rather between higher and lower levels of labour-market security, at least for men. Men with good job prospects, both employed and unemployed, are strongly negatively affected by regional unemployment. However, insecure employed men and poor-prospect unemployed men are less negatively, or even positively, affected. There is however no clear relationship for women. We analyse labour-market inequality and unemployment hysteresis in the light of our results.

I use daily data on self-reported well-being (SWB) to examine how the Great Recession affected the emotional and evaluative lives of the population. In the fall of 2008 and lasting into the spring of 2009, at the bottom of the stock market, Americans reported sharp declines in their life evaluation, sharp increases in worry and stress, and declines in positive affect. By the end of 2010, in spite of continuing high unemployment, these measures had largely recovered. The SWB measures do a better job of monitoring short-run levels of anxiety than the medium-term evolution of the economy. Even very large macroeconomic shocks will cause small and hard to detect effects on SWB. Life evaluation questions are extremely sensitive to question order effects—asking political questions first reduces reported life evaluation by an amount that dwarfs the effects of even the worst of the crisis.

Economic crises are complex events that affect behavioral patterns (including alcohol consumption) via opposing mechanisms. With this realist systematic review, we aimed to investigate evidence from studies of previous or ongoing crises on which mechanisms (How?) play a role among which individuals (Whom?). Such evidence would help understand and predict the potential impact of economic crises on alcohol consumption. Medical, psychological, social, and economic databases were used to search for peer-reviewed qualitative or quantitative empirical evidence (published January 1, 1990–May 1, 2014) linking economic crises or stressors with alcohol consumption and alcohol-related health problems. We included 35 papers, based on defined selection criteria. From these papers, we extracted evidence on mechanism(s), determinant, outcome, country-level context, and individual context. We found 16 studies that reported evidence completely covering two behavioral mechanisms by which economic crises can influence alcohol consumption and alcohol-related health problems. The first mechanism suggests that psychological distress triggered by unemployment and income reductions can increase drinking problems. The second mechanism suggests that due to tighter budget constraints, less money is spent on alcoholic beverages. Across many countries, the psychological distress mechanism was observed mainly in men. The tighter budget constraints mechanism seems to play a role in all population subgroups across all countries. For the other three mechanisms (i.e., deterioration in the social situation, fear of losing one's job, and increased non-working time), empirical evidence was scarce or absent, or had small to moderate coverage. This was also the case for important influential contextual factors described in our initial theoretical framework. This realist systematic review suggests that among men (but not among women), the net impact of economic crises will be an increase in harmful drinking. Such a different net impact between men and women could potentially contribute to growing gender-related health inequalities during a crisis.

The importance of economic well-being is recognised in the recent UK Government policy. Older people may be particularly vulnerable to economic fluctuations as they are reliant on fixed incomes and assets, which are reducing in value. Within the literature, little is understood about the impact of the current economic downturn on people’s general quality of life and well-being and, in particular, there is little research on the financial experiences and capability of the older age group, a concern in light of the ageing UK population. This article reports a qualitative research study into the nature of older peoples’ vulnerability by exploring their perceptions of the impact of the economic recession on their well-being and quality of life. It explores specifically a group of older people who are not the poorest within the ageing population, but who may be described as the ‘asset rich-income poor’ group. Key themes relate to the impact of the recession on the costs of essential and non-essential items and dimensions of mental, physical and social well-being. Implications for health and social care practice in meeting the needs of older people during times of economic recession are then explored. The paper adds to the debate by demonstrating that the recession is having adverse consequences for older people’s quality of life in terms of economic, mental and social well-being, although there is also evidence that some of them are equipped with certain resilience factors due to their money management and budgeting skills.

The macroeconomic context and crisis management are now becoming salient issues among employees. Low levels of fear about the economic situation and the belief that one is capable of obtaining new employment may enable individuals to maintain mental health and job satisfaction in austere times. The aim of the present study is to investigate the relationship of fear of the economic crisis and nonemployability with job satisfaction and psychological distress, while controlling for demographics factors, stress exposures, and high conflict perceptions. This cross-sectional study was conducted in 3 Italian organizations comprising 679 workers with a response rate of more than 60%. Hierarchical regression analysis showed that, after controlling for demographics, psychological demands, lack of job control, and workplace bullying, low perceived employability and fear of the economic crisis were positively associated with psychological distress and negatively associated with job satisfaction. As an emerging topic of study, it appears that economic stress is an important construct in the nomological network for studying organizational health. The present study complements existing stress theories by suggesting that features of the external environment are relevant and important determinants of psychological distress and job dissatisfaction. (PsycINFO Database Record (c) 2015 APA, all rights reserved)

Background: Theory and empirical evidence suggest that economic contraction predicts increased incidence of psychological disorder. The extent to which this relation can be causally attributed to the economic experiences of individuals remains uncertain. Methods: We critically examine literature concerning the impact of economic contraction, measured at the individual or ecological level, on four mental health outcomes (depression, suicide, substance abuse, and antisocial behavior) from the past two decades. Studies at the individual level use job loss, transition to inadequate employment, or welfare as the independent variable. Studies at the ecological level primarily use the unemployment rate. Results: In the studies that best establish causality, research indicates a moderate but significant adverse effect of job loss on individual depression symptoms, but the net population effect remains speculative. For suicide and antisocial behavior, individual- and ecological-level studies converge to suggest a moderate positive association with economic contraction. Although some research on substance abuse suggests procyclical effects, the majority indicate that job loss significantly increases the risk of heavy drinking and symptoms of alcohol abuse. For all outcomes, various characteristics of the population or the specific economic exposure studied can modify the overall association. Conclusions: The studies reviewed suggest that adverse economic transitions predict increased mental health problems, particularly depression, suicide, and substance abuse. The strength of the association, particularly when measuring the response of populations to contracting economies remains unclear.

Objectives. We examined the mental health effects of the Great Recession of 2008 to 2009 on workers who remained continuously employed and insured.

Methods. We examined utilization trends for mental health services and medications during 2007 to 2012 among a panel of workers in the 25 largest plants, located in 15 states, of a US manufacturing firm. We used piecewise regression to compare trends from 2007 to 2010 in service and medication use before and after 2009, the year of mass layoffs at the firm and the peak of the recession. Our models accounted for changes in county-level unemployment rates and individual-level fixed effects.

Results. Mental health inpatient and outpatient visits and the yearly supply of mental health–related medications increased among all workers after 2009. The magnitude of the increase in medication usage was higher for workers at plants with more layoffs.

Conclusions. The negative effects of the recession on mental health extend to employed individuals, a group considered at lower risk of psychological distress.

Background How have suicide rates responded to the marked increase in unemployment spurred by the Great Recession? Our paper puts this issue into a wider perspective by assessing (1) whether the unemployment-suicide link is modified by the degree of unemployment protection, and (2) whether the effect on suicide of the present crisis differs from the effects of previous economic downturns.

Methods We analysed the unemployment-suicide link using time-series data for 30 countries spanning the period 1960–2012. Separate fixed-effects models were estimated for each of five welfare state regimes with different levels of unemployment protection (Eastern, Southern, Anglo-Saxon, Bismarckian and Scandinavian). We included an interaction term to capture the possible excess effect of unemployment during the Great Recession.

Results The largest unemployment increases occurred in the welfare state regimes with the least generous unemployment protection. The unemployment effect on male suicides was statistically significant in all welfare regimes, except the Scandinavian one. The effect on female suicides was significant only in the eastern European country group. There was a significant gradient in the effects, being stronger the less generous the unemployment protection. The interaction term capturing the possible excess effect of unemployment during the financial crisis was not significant.

Conclusions Our findings suggest that the more generous the unemployment protection the weaker the detrimental impact on suicide of the increasing unemployment during the Great Recession.

Methods: Longitudinal data came from the Health and Retirement Survey and the Survey of Health, Ageing, and Retirement in Europe. Workers aged 50 to 64 years in 13 European countries and the USA were assessed biennially from 2006 to 2010. Individual fixed effects models were used to test the effect of job loss on depressive symptoms, controlling for age, sex, physical health, initial wealth and socio-demographic factors.

Results: Job loss was associated with a 4.78% [95% confidence interval (CI): 0.823% to 8.74%] increase in depressive symptoms in the USA compared with a 3.35% (95% CI: 0.486% to 6.22%) increase in Europe. Job loss due to a worker’s unexpected firm closure increased depression scores in both the USA (beta = 28.2%, 95% CI: 8.55% to 47.8%) and Europe (beta = 7.50%, 95% CI: 1.25% to 13.70%), but pooled models suggested significantly stronger effects for US workers (P < 0.001). American workers who were poorer before the recession experienced significantly larger increases in depressive symptoms compared with wealthier US workers (beta for interaction = −0.054, 95% CI: −0.082 to −0.025), whereas pre-existing wealth did not moderate the impact of job loss among European workers.

Conclusions: Job loss is associated with increased depressive symptoms in the USA and Europe, but effects of job loss due to plant closure are stronger for American workers. Wealth mitigates the impact of job loss on depression in the USA more than in Europe.

Ireland is experiencing the worst recession since the foundation of the state, and the effects on the labour market have been dramatic. This article explores the impact of recession for those still in employment by examining work pressure, using two large, nationally representative workplace surveys from 2003 (boom) and 2009 (recession). We find a significant increase in work pressure between 2003 and 2009. Staff reductions and company reorganization are both associated with increased work pressure, as is current job insecurity. Other job changes, like large pay cuts, increases in responsibility and monitoring are also associated with increased work pressure. We argue that negative organizational and job changes in the previous two years play an important role in accounting for the rise in work pressure.

Using a sample of 222 young adults attending college, the present study examined the relative contribution of young adults’ perceived economic pressures, financial coping and religious meaning-making coping strategies in accounting for variation in their reports of psychological well-being within the context of the United States economic crisis. Results suggest a direct relationship between perceived economic pressure and psychological well-being such that young adults who reported having to make more economic adjustments as a result of economic crisis also reported higher levels of depressed mood and anxiety. Young men and women who reported having to make fewer economic adjustments and being able to meet their material needs reported higher levels of life satisfaction. Regardless of young adults’ self-reported level of economic pressures, the use of education and communication financial coping strategies was related to lower levels of self-reported anxiety and depressed mood and greater life satisfaction. Viewing the financial crisis as a punishment from God was generally associated with young adults’ reports of greater depressed mood and less life satisfaction. Implication of findings for research and practice are discussed.

The present intergenerational study examined the perceived impact of the recent U.S. economic crisis on a sample of 68 young adult–parent dyads. The relative contribution of perceived economic pressure, reports of adult child–parent relationship quality, and concerns about the economic future in accounting for variation in self-reports of psychological distress for adult children and their middle-aged parents were examined. Parents' concerns about their children's economic future accounted for variation in their reports of anxiety and depressed mood above and beyond that of perceived economic pressures and their views of the parent–child relationship. In contrast, for young adults, reports of personal economic pressure were generally related to self-reported anxiety and depressed mood. Implications of findings for research and practice are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved)

This study examined the psychological effects of an economic crisis based on Conservation of Resources (COR) stress theory. It investigated how the loss of economic resources had a psychological influence on well-being and identified which of 3 variables (the loss of economic resources, demographic characteristics, or coping strategies) had the greatest psychological influence. Psychological well-being was assessed via levels of anxiety and anger. The study provided clear support for COR theory. The loss of economic resources had a strong and mostly positive relationship to anxiety and anger. The coping strategies were the most important of several predictors. Similar studies were proposed to increase confidence in generalizing to other populations and to identify the causal links between loss of economic resources, coping, and psychological well-being. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Purpose of review: Literature from the past year was examined to learn whether economic recessions have an effect on mental disorders including depression and suicides.

Recent findings: Economic recessions and crises have a context-dependent negative impact on mental health disorders. These appear in low-income and middle-income countries whereas some affluent countries are offering provisions that help unemployed persons to escape the detrimental consequences.

Summary: The Asian economic crisis led to a sharp unemployment-related increase in suicide mortality in east Asian countries. In European Union countries rising unemployment was associated with significant short-term increases in premature deaths from intentional violence including suicides. It seems that active labour market programmes existing in some Organization for Economic Cooperation and Development countries can prevent some adverse health effects of economic downturns. As mental health consequences of economic crises are context dependent, the current situation needs monitoring. Enough services for those in need should be provided and advocacy for societal support measures is of great importance.

While most research has examined the long-term effects of alcohol consumption on health, the current study examines how health status impacts on drinking behavior. Using data from a national study conducted between 2010 and 2011 to assess the impact of the recession on drinking behavior, this study examines how economic hardships linked to the recent economic recession affect physical health, and how physical health may in turn affect alcohol use. Structural equation models were used to test the predicted associations. The data demonstrate that many of the economic stressors linked to the recession are associated with increased somatic symptoms. Somatic symptoms are also associated with increased drinking for men, but not for women. These findings suggest that men may use alcohol to self medicate somatic symptomatology. The current findings are consistent with gender role-based explanations that account for gender disparities in the utilization of medical care.

Objective:We examined whether race/ethnicity was related to exposure to acute economic losses in the 2008–2009 recession, even accounting for individual-level and geographic variables, and whether it influenced associations between economic losses and drinking patterns and problems.

Results:Compared with Whites, Blacks reported significantly greater exposure to job loss and trouble paying the rent/mortgage, and Latinos reported greater exposure to all economic losses. However, only Black–White differences were robust in multivariate analyses. Interaction tests suggested that associations between exposure to economic loss and alcohol problems were stronger among Blacks than Whites. Given severe (vs. no) loss, Blacks had about 13 times the odds of both two or more drinking consequences and alcohol dependence, whereas the corresponding odds ratios for Whites were less than 3. Conversely, associations between economic loss and alcohol outcomes were weak and ambiguous among Latinos.

Conclusions:Results suggest greater exposure to economic loss for both Blacks and Latinos (vs. Whites) and that the Black population may be particularly vulnerable to the negative effects of economic hardship on the development and/or maintenance of alcohol problems. Findings extend the economic literature and signal policy makers and service providers that Blacks and Latinos may be at special risk during economic downturns.

Prior research suggests that the current global economic crisis may be negatively affecting population mental health. In that context, this paper has several goals: (1) to discuss theoretical and conceptual explanations for how and why economic downturns might negatively affect population mental health; (2) present an overview of the literature on the relationship between economic recessions and population mental health; (3) discuss the limitations of existing empirical work; and (4) highlight opportunities for improvements in both research and practice designed to mitigate any negative impact of economic declines on the mental health of populations. Research has consistently demonstrated that economic crises are negatively associated with population mental health. How economic downturns influence mental health should be considered in policies such as social protection programs that aim to promote recovery.